Dead on arrival in a low-income country: Results from a multicenter study in Pakistan

Munawar Khursheed, Junaid Ahmad Bhatti, Fatima Parukh, Asher Feroze, Syed Saad Naeem, Haseeb Khawaja, Junaid Abdul Razzak

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11 Citations (Scopus)


Background: This study assessed the characteristics of dead on arrival (DOA) patients in Pakistan. Methods: Data about the DOA patients were extracted from Pakistan National Emergency Department Surveillance study (Pak-NEDS). This study recruited all ED patients presenting to seven tertiary care hospitals during a four-month period between November 2010 and March 2011. This study included patients who were declared dead-on-arrival by the ED physician. Results: A total of 1,557 DOA patients (7 per 1,000 visits) were included in the Pak-NEDS. Men accounted for two-thirds (64%) of DOA patients. Those aged 20-49 years accounted for about 46% of DOA patients. Nine percent (n = 72) of patients were brought by ambulance, and most patients presented at a public hospital (80%). About 11% of DOA patients had an injury. Factors significantly associated (p < 0.05) with ambulance use were men (adjusted odds ratio [aOR] = 2.72), brought to a private hospital (OR = 2.74), and being injured (aOR = 1.89). Cardiopulmonary resuscitation (CPR) was performed on 6% (n = 42) of patients who received treatment. Those brought to a private hospital were more likely to receive CPR (aOR = 2.81). Conclusion: This study noted a higher burden of DOA patients in Pakistan compared to other resourceful settings (about 1 to 2 per 1,000 visits). A large proportion of patients belonging to productive age groups, and the low prevalence of ambulance and CPR use, indicate a need for improving the prehospital care and basic life support training in Pakistan.

Original languageEnglish
Article numberS8
JournalBMC Emergency Medicine
Issue number2
Publication statusPublished - 11 Dec 2015


  • Cardiopulmonary resuscitation
  • Critical illness
  • Prehospital care
  • Surveillance


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